In the News
Sept 8, 2004
Contact: Liz Beckett, (520) 626-5954
or Dr. Wayne Morgan (520) 626-7780
Study Published in the New England Journal of Medicine Identifies Strategies for Reducing Asthma Symptoms in Inner City Children
A program that targets allergens and tobacco smoke in the home resulted in fewer asthma symptoms in children participating in the intervention than in those who were not, according to a new study sponsored by the National Institutes of Health (NIH). Children participating in the intervention had 21 fewer days of asthma symptoms over the one-year course of intervention.
The Arizona Respiratory Center at the University of Arizona Health Sciences Center participated in The Inner City Asthma Study, a cooperative, multi-center study in seven metropolitan areas. Wayne Morgan, MD, associate director of the Arizona Respiratory Center and UA professor of pediatrics and physiology is chair of the steering committee and first author of the Inner City Asthma Study - published in the September 9th issue of the New England Journal of Medicine.
"This research is very exciting because it can make a meaningful difference in the lives of the millions of children, families, and caregivers dealing with asthma on a day-to-day basis," says Dr. Morgan. "Study results demonstrate that successful environmental remediation strategies can improve asthma symptoms and empower families to play an active role improving their children's health and quality of life."
Asthma, a chronic lung disease is characterized by coughing, wheezing and difficulty breathing and affects roughly 20 million Americans. Children who live in the inner city - in particular African-American and Hispanic children - suffer disproportionately from the disease. Increased asthma symptoms in this population may stem from exposure to high levels of multiple indoor allergens and tobacco smoke.
More than 900 children ages 5 to 11 with moderate to severe asthma participated in the study. Each participant had to be allergic to at least one common indoor environmental allergen, such as cockroach allergen or house mite allergen. Once accepted into the study, they were randomly assigned to either the intervention group or a control group.
Based on the child's sensitivity to the selected indoor allergens and evidence of exposures at home known asthma triggers, investigators designed an individualized environmental intervention, carried out by the child's mother or another caretaker. The intervention focused on educating the family about ways to reduce or eliminate all allergens to which the child was allergic, as well as to reduce exposure to tobacco smoke, and motivating them to pursue these steps. The investigators developed separate interventions tailored to tobacco smoke and to the following allergens - house dust mite, cockroach, pet, rodent and mold.
In addition, families were given specific allergen-reducing measures, such as allergen-impermeable cover for children's bedding and air purifiers with HEPA (high efficiency particulate air) filters, to be placed in key locations within their homes, including the children's bedroom. Cockroach extermination visits were provided for children who were allergic to cockroach allergens. During the first year of the study, the investigators conducted educational home visits with the families in the intervention group. Throughout the yearlong study and the one-year follow-up, researchers closely monitored all participants' asthma symptoms and home allergen levels.
Children who participated in the intervention had significantly fewer asthma symptoms compared with those in the control group: an average of 21 fewer days of symptoms in the first year and an average of 16 fewer days during the second, or follow-up year. In addition, the benefits of the intervention occurred rapidly: Investigators noted significant reduction in symptoms just 2 months after the study began.
The levels of cockroach and dust mite allergens in the children's bedrooms in the intervention group were substantially lower than in the control group. Furthermore, the researchers noted a direct correlation between allergen levels and asthma symptoms for the children in the intervention group: The greater the drop in cockroach or house dust mite allergen levels, the greater the reduction in asthma symptoms, suggesting that the allergy-reducing measures made the difference.
Most previous environmental intervention studies that have focused on controlling a single allergen or tobacco smoke, and met with limited success. Inner-city children with asthma are commonly exposed to multiple indoor allergens and environmental tobacco smoke.
"While this study focused on inner-city children, and it is difficult to generalize to all children with asthma, it seems likely that those exposed to environmental allergens and irritants similar to these inner-city study participants may show a similar improvement from this intervention," says Dr. Morgan.
The Inner City Asthma Study was co-funded by two NIH institutes - the National Institute of Allergy and Infectious Diseases (NIAID) and the National Institute of Environmental Health Sciences (NIEHS).
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EDITORS NOTE: The Arizona Respiratory Center was designated the first Center of Excellence at the UA College of Medicine 1971. Today, the internationally known Center combines the highest caliber of research, clinical care and teaching. The Center is recognized as one of the top institutions for respiratory care.
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